Variability in quality improvement measures across Australian PHN regions

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It is an interesting time for quality improvement in primary care, with new comparative data reports as well as new software tools available in the market.

Last week the Australian Institute of Health and Welfare (AIHW) published the first national report on data collected from 5,700 general practices by Primary Health Networks (PHNs) across ten improvement areas spanning chronic illness, risk screening and influenza immunisation (see full list  below).

This landmark report provides a unique insight into general practice data quality and peoples’ health status, by PHN region, for 2019-2020. It provides PHNs a timely opportunity to compare themselves on a national scale, identifying areas and strategies for improvement.

Some of the insights about general practice patients include:

  • Smoking rates ranged from 7.4% in Northern Sydney to 23.5% in Western Queensland; however only 62.9% of patients aged 15+ years nationally had a smoking status recorded
    • The Royal Australian College of General Practitioners (RACGP) has clear recommendations on how to identify and record people who smoke, and on smoking cessation strategies[1].
  • Only 32.5% of regular patients aged 15+ years had their height and weight recorded. Of those with a record, 39.8% were classified as obese and 32.5% were classified as overweight[2].
    • The proportion of patients classified as obese ranged from 25.2% in Northern Sydney to over 48% in Country SA, Western Queensland and Western NSW
    • Urban areas including Sydney and Gold Coast had the highest proportion of unhealthy underweight patients
    • The data paints an alarming picture, with two in three Australians overweight or obese.
  • Of patients with diabetes recorded, 58.7% had blood pressure recorded in the last six months and 58.2% had influenza immunisation recorded, with both rates pleasingly increasing in the last 9 months. A patient is much more likely to have either or both measures recorded if they are older than 55 years. A patient is more likely to have HbA1c recorded if they have Type 2 diabetes than if they had Type 1 diabetes or undefined diabetes.

PHNs are an essential driver of quality improvement in general practice. In our work with PHNs and individual general practices we have observed a need for:

  • training for PHN staff on how to engage and interact with general practice managers, nurses and GPs strategically to achieve quality improvement goals
  • a continued focus on data quality (data cleansing)
  • support for the mental health and wellbeing of practice staff and clinicians during this very challenging time, so that there remains a supported workforce that continues to focus on chronic illness prevention and management despite the immediate need to focus on COVID-19 (indeed, many clinicians are worried for chronically ill patients avoiding general practice care)
  • training of nurses and GPs on how to best engage patients and motivate behaviour change via telephone and videoconference.

At Larter, some of the project work we are doing with PHNs and other partners includes implementing and evaluating social prescribing models – lifestyle modification through non-clinical prescription. Clinicians have strongly embraced the concept and we’ve worked hard to assist them to seamlessly integrate social prescribing both digitally and in paper form.   

With a rural PHN we are also undertaking a general practice “prevention through the MBS” project. This includes training and mentoring PHN practice engagement staff to continue and scale the work once our component is finished.   

Given the work Larter is currently delivering to support various Australian PHNs, our team has very current, relevant and embedded experience in improving data recording in general practice and helping affect change through the quality improvement population health initiatives.

Talk to us if you would like to explore how we can support your PHN to improve population health in partnership with general practice.

Ten Practice Incentive Program (PIP) Quality Incentive (QI) Measures

  1. Diabetes types with HbA1c recorded
  2. Smoking status recorded
  3. Height, weight and BMI recorded
  4. Influenza immunisation recorded for 65+ years
  5. Alcohol consumption recorded
  6. Risk factors recorded for cardiovascular disease assessment
  7. Cervical screening test recorded
  8. Diabetes with blood pressure recorded
  9. Cervical screening test recorded
  10. Diabetes with blood pressure recorded.

[1] Royal Australian College of General Practitioners, Supporting smoking cessation: a guide for health professionals, December 2019

[2] Australian Institute of Health and Welfare, Practice incentives program quality improvement: national report on the first year of data 2020-21, August 2021